Evaluation of mesh fixation versus non-fixation in laparoscopic mesh hernioplasty in inguinal hernias

 Background: Laparoscopic inguinal hernia repair (LIHR) is usually done by two methods, which vary in approach to the preperitoneal space; transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP). This study aimed at comparing the effect of mesh fixation and non-fixation in terms of operative time, hospital stay, analgesic requirement, complications and cost analysis with respect to fixation device in LIHR.Methods: This prospective randomized comparative study included 60 patients of inguinal hernias admitted to the Department of Surgery at Rajendra Hospital, G.M.C, Patiala from July 2016 to September 2017 (duration of study was 15 months). Cases were divided into two groups by draw of lots with group A as mesh fixation (n=30) and group B as non-fixation (n=30).Results: The results were calculated with chi square test (p value). Results were found to be not significant in two groups in the terms of postoperative analgesia, complications i.e. (intraoperative, postoperative and long term) postoperative hospital stay and time to return for work. The cost of procedure was found to be very high in Group A and results were highly significant (p<0.001).Conclusion: LIHR repair without mesh fixation shows advantages over mesh fixation, which includes significant less cost of surgery, with comparable intraoperative, postoperative and long-term complications (with no increase in hernia recurrence), hospital stay and mean operative time. Hence, our study favours LIHR without mesh fixation a valuable alterative option.

A Prospective Comparative Clinical Study on Repair of Paraumbilical Hernias with Mayo’s and Mesh Techniques and their Postoperative Complications

Background: “Paraumbilical hernia” occurs through Linea Alba either above or below umbilicus. The current trend is to use a mesh forthe repair irrespective of the size. The conventional suture method of Mayo’s is also being practiced in various centers. An attempt ismade in this study to compare both the methods especially in relation to their post-operative complications in the long-term follow-up.Aim of the Study: The aim of the study to study and compare Mayo’s method and use of mesh technique in the surgicalmanagement of repair of paraumbilical hernias in relation to their post-operative complications.Materials and Methods: A cross-sectional prospective clinical study was conducted in the Department of General Surgeryof Malabar Medical College Hospital, Modakkallur. Atholi, Kozhikode, Kerala, wherein 58 patients undergoing surgery forparaumbilical hernia were included in the study. The patients were assigned to these groups using random numbers from www.randomizer.org. The patients belonging to Group A were subjected to Mayo’s operation and Group B were subjected to Meshtechnique. All the patients were asked thorough history taking followed by investigations of surgical profile before undertakingthe surgery. All the patients were followed up from day 1 postoperatively for 2 years.Observations and Results: A total of 58 patients with paraumbilical hernia were divided into 2 equal groups comprising of29 each. The mean age in Group A was 43.65 ± 4.10 years and in Group B was 44.60 ± 3.20 years. There were 18 femalesand 11 males in Group A and 17 females and 12 males in Group B. The patients belonging to the age group of 33–62 yearswere 21/29 (72.41%) in group A and 23/29 (79.31%) in Group B. There was no statistical significance in the incidence amongthe two groups as P = 0.153 (P taken significantly at <0.05). The male to female ratio in Group A was 1:1.63 and 1:1.41 inGroup B. Pain was complained in the post-operative period in 19/29 (65.51%) patients in Group A and 16/29 (55.17%) patientsin Group B. Hematoma was observed in 5/29 (17.24%) patients in Group A and 7/29 (24.13%) patients in Group B. Seromawas observed in 4/29 (13.79%) patients in Group A and 3/29 (10.34%) patients in Group B.Conclusions: In a follow-up of 2 months to years, among the procedures used classical Mayo’s repair had 4/29 recurrencesand 1/29 were noted in patients underwent mesh repair. Even though Mayo’s repair for paraumbilical has been the procedureof choice in many centers, but the tension-free mesh repair has an advantage of having no recurrences and can be used in thepresence of bigger defect and weaker abdominal muscle tone, thus showing a superior and favorable procedure than Mayo’s repair.

Traumatic lumbar hernia: clinical features and management

PURPOSE: Traumatic lumbar hernia is rare, thus making diagnosis and proper treatment challenging. Accordingly, we aimed to investigate the clinical manifestations and proper management strategies of traumatic lumbar hernias. METHODS: The medical records of patients with traumatic lumbar hernia treated at Gachon University Gil Hospital from March 2006 to February 2015, were retrospectively reviewed. RESULTS: We included 5 men and 4 women (mean age, 55 years; range, 23–71 years). In 8 patients, most injuries were caused by motor vehicle collisions, including those wherein a pedestrian was struck (5 cases of car accidents, 2 falls, and 1 involving penetrating materials); in 1 patient, the probable cause was severe cough. Eight patients underwent hernia repair surgery (5 open and 3 laparoscopic), and a prosthetic mesh was used in 7 patients. Hernia repairs were elective in 7 patients; emergency hernia repair was performed with right hemicolectomy in 1 patient. No severe complication or recurrence was observed. Only 2 patients had mild complications, such as postoperative seroma. CONCLUSION: Traumatic lumbar hernia is a relatively rare injury of the posteriolateral abdominal wall. Lumbar hernia should be suspected in patients with high-energy injuries of the torso, and all such patients should undergo abdominopelvic computed tomography. After diagnosis, hernia repair can be electively performed without complications in most cases.

Incisional and Ventral Hernia Repair

Incisional or ventral hernia is a very common multifactorial disease that requires surgery to prevent complications, including pain, discomfort, bowel obstruction, incarceration, and strangulation. To perform herniorrhaphy, it is essential to understand the pathogenesis of hernia, the anatomy and physiology of the abdominal wall, and surgical techniques. Several repair methods are available, including open suture repair, open mesh repair, the component separation technique, and tissue expansion assisted closure. Currently, laparoscopic incisional or ventral hernia repair is commonly used with the major advantage being the lower recurrence and all defects can be addressed at the time of surgery as well as reduced postoperative pain and length of hospital stay. On the other hand, to do it properly, a full understanding and appropriate selection of mesh and management of probable complications, such as seroma, bowel injury, enteric fistula, and recurrence, is essential. Therefore, the surgeon and the techniques used are of paramount importance in the repair of incisional ventral hernias.

Postoperative analgesia of Ropivacaine combined Dexmedetomidine for transversus abdominis plane block in laparoscopic surgery / 中国内镜杂志

Objective To observe the effect of postoperative analgesia of Ropivacaine combined Dexmedetomidine for transversus abdominis plane (TAP) block in laparoscopic surgery. Methods 60 patients underwent selective laparoscopic hernia repair were randomly divided into two groups: Ropivacine plus Dexmedetomidine group (Rpd group): Dexmedetomidine 1.0 μg/kg + 0.4% Ropivacine 30 ml was injected into bilateral TAP, and Ropivacine group (R group): saline 1 ml+0.4% Ropivacine 30 ml was injected into bilateral TAP. Blood pressure and heart rate on beginning of the surgery, 1 h during surgery and leaving the operating room, VAS of immediate postoperative period, 4 h, 6 h, 8 h, 12 h, 24 h after the surgery, analgesic duration and incidence of nausea and vomiting of the two groups were recorded. Results Two groups have no difference in blood pressure and heart rate in all time points (P > 0.05), VAS score of 6 h, 8 h, 12 h after surgery in Rpd group were lower than in R group (P < 0.05), and VAS score of postoperative period, 4 h, 24 h after the surgery had no difference between the two groups (P > 0.05). Sensory block duration in Rpd group was longer than in R group (P < 0.05). Incidence of nausea and vomiting of the two groups had no difference in two groups (P > 0.05). Conclusions Ropivacaine combined Dexmedetomidine for Transversus Abdominis Plane block in laparoscopy patients can significantly prolong the analgesic duration.

Postoperative analgesia of Ropivacaine combined Dexmedetomidine for transversus abdominis plane block in laparoscopic surgery / 中国内镜杂志

Objective To observe the effect of postoperative analgesia of Ropivacaine combined Dexmedetomidine for transversus abdominis plane (TAP) block in laparoscopic surgery. Methods 60 patients underwent selective laparoscopic hernia repair were randomly divided into two groups: Ropivacine plus Dexmedetomidine group (Rpd group): Dexmedetomidine 1.0 μg/kg + 0.4% Ropivacine 30 ml was injected into bilateral TAP, and Ropivacine group (R group): saline 1 ml+0.4% Ropivacine 30 ml was injected into bilateral TAP. Blood pressure and heart rate on beginning of the surgery, 1 h during surgery and leaving the operating room, VAS of immediate postoperative period, 4 h, 6 h, 8 h, 12 h, 24 h after the surgery, analgesic duration and incidence of nausea and vomiting of the two groups were recorded. Results Two groups have no difference in blood pressure and heart rate in all time points (P > 0.05), VAS score of 6 h, 8 h, 12 h after surgery in Rpd group were lower than in R group (P < 0.05), and VAS score of postoperative period, 4 h, 24 h after the surgery had no difference between the two groups (P > 0.05). Sensory block duration in Rpd group was longer than in R group (P < 0.05). Incidence of nausea and vomiting of the two groups had no difference in two groups (P > 0.05). Conclusions Ropivacaine combined Dexmedetomidine for Transversus Abdominis Plane block in laparoscopy patients can significantly prolong the analgesic duration.

Application of photoplethysmography in monitoring changes of noxious stimulation intensity during pediatric laparoscopic hernia repair / 第二军医大学学报

To explore the feasibility of photoplethysmography in monitoring the changes of noxious stimulation intensity caused by veress needle insertion during pediatric laparoscopic hernia repair. Methods Ninety pediatric patients (2-4 years old) with the American Society of Anesthesiologists (ASA) grade of I-II scheduled for laparoscopic hernia repair surgery were randomized into three groups (n=30): group A, B, and C. After tracheal intubation of general anesthesia induction, the pediatric patients in group A received intravenous 0.1 μg/kg sufentanil 5 min before veress needle insertion, group B received 0.1 μg/kg sufentanil immediately after placing the veress needle, while group C received veress needle insertion without sufentanil. The photoplethysmographic amptitude (PPGA) from right forefinger, and surface electromyography (sEMG) of abdominal muscles of pediatric patients were recorded at 6 min prior to veress needle insertion (that is 1 min before receiving sufentanil in the group A, and the injection time was not included, T1), immediately after veress needle insertion (T2), and at 5 min after veress needle insertion (that is 5 min after administration of sufentanil in the group B, T3). Results The values of PPGA had no significant difference between T1, T2 and T3 in group A (P>0.05). Compared with T1 and T3, the value of PPGA at T2 was significantly decreased in group B (P<0.05). The values of PPGA at T2 and T3 were significantly decreased compared with T1 in group C (P<0.05). PPGA was negatively correlated with sEMG in three groups (r=-0.601, -0.512, -0.613; P<0.05). Conclusion Photoplethysmography can quantify the changes of noxious stimulation intensity in pediatric laparoscopic hernia repair and has good application values.

Comparison of the treatment effects of extraperitoneal laparoscopic hernia repair and traditional hernia repair in the treatment of inguinal hernia / 中国基层医药

Objective To compare the curative effects of extraperitoneal laparoscopic hernia repair and tradi-tional hernia repair in the treatment of inguinal hernia.Methods The clinical data of 200 inguinal hernia patients in our hospital from October 2013 to Novermber 2015 were retrospectively analyzed.They were divided into traditional hernia repair group (100 cases)and laparoscopic hernia repair group (100 cases)according to different surgical treatment.The operation time,bed activity time and hospital stay of the two groups were detected.The uroschesis, hydrocele,incidence of postoperative pain and recurrence rate of the two groups were detected.Results The opera-tion time between the two groups had no significant difference(t =1.74,P >0.05).The bed activity time[(2.6 ± 1.6)h]and hospital stay[(5.7 ±2.1 )d]of the laparoscopic hernia repair group were better than the traditional hernia repair group[(9.1 ±3.3)h,(7.4 ±2.3)d,t =17.72,5.46,all P <0.05].The uroschesis 3.0%,hydrocele 0,incidence of postoperative pain 10.0% and recurrence rate 0 of the laparoscopic hernia repair group were lower than the traditional hernia repair group(21.0%,15.0%,50.0%,12.0%,χ2 =15.17,15.34,39.11,11.69,all P <0.05).Conclusion The recovery is fast in inguinal hernia patients treatment by extraperitoneal laparoscopic hernia repair,complication is little,which is worthy of application.

Reparación de hernia incisional por vía laparoscópica: resultados iniciales / Laparoscopic repair of incisional hernias: experience in 21 patients

Background: Ventral hernias are one of the most common complications of open abdominal surgery and can be repaired laparoscopically. Aim: To assess the feasibility, safety and efficacy of the laparoscopic repair of incisional hernias. Patients and Methods: Retrospective study of the patients undergoing laparoscopic ventral hernia repair from march 2006 to october 2008 at a surgical department of a clinical hospital. We analyzed patient's characteristics, surgical variables, perioperative results, complications and short term follow up. Results: Twenty-one patients aged 54 +/- 14 years (16 females) underwent laparoscopic ventral hernia repair during this period. Their mean body mass index was 32.2 +/-6.5 kg/m². One patient was converted to open surgery. The mean hernia ring diameter was 8.4 +/- 3.9 cm (range 3-17). Median operative time was 92 minutes (range 45-300). Mean hospital stay was 3.0 +/-1.6 days. During the procedure, two patients were simultaneously subjected to a sleeve gastrectomy and cholecystectomy, respectively. Apulmonary atelectasis and a seroma occurred in two patients (10 percent) as early minor complications. As late complications, two patients (10 percent) experienced continuing pain in the area in both operations. No patient died. Follow up was 100 percent with a mean of 14 months (range 4-36), without hernia recurrence during this period. Conclusions: Laparoscopic incisional hernia repair is a feasible technique to perform, without serious complications.

Introducción: La hernia incisional (HI) es una de las complicaciones más frecuentes en cirugía abdominal abierta, siendo una alternativa para su corrección la hernioplastía por vía laparoscópica. El objetivo de este trabajo fue evaluar la factibilidad y eficacia de la reparación laparoscópica de la HI con seguimiento a corto plazo, dando a conocer nuestra experiencia inicial. Material y Método: Estudio retrospectivo de pacientes sometidos a hernioplastía incisional laparoscópica entre marzo de 2006 y octubre de 2008 en el Hospital Clínico de la Pontificia Universidad Católica de Chile. Se evaluó variables demográficas, perioperatorias, morbilidad y recidiva. Resultados: Fueron operados 21 pacientes en este período, 16 de género femenino, con un promedio de edad e índice de masa corporal de 54 +/- 13 años y 32,2 +/- 6,5 kg/m², respectivamente. Uno de ellos se convirtió a cirugía abierta. El diámetro mayor del anillo hemiario fue en promedio 8,4 +/-3,9 cm (rango 3-17) y la mediana de tiempo operatorio fue de 92 minutos (rango 45-300). La estadía hospitalaria fue 3,0 +/-1,6 días, en promedio. Durante la misma cirugía se realizó en dos pacientes gastrectomía en manga y colecistectomía. Se presentaron complicaciones precoces menores en dos pacientes (10 por ciento), una atelectasia pulmonar y un seroma, y complicaciones tardías menores en otros dos pacientes (10 por ciento), que correspondió a dolor prolongado en la zona operatoria en ambos. No hubo mortalidad en la serie. El seguimiento fue 100 por ciento, con un promedio de 14 meses (rango 4-36), sin recidiva en este período. Conclusiones: La hernioplastía incisional laparoscópica es una técnica factible de realizar en nuestro medio, sin complicaciones mayores en esta serie y buenos resultados a un a±o de seguimiento.

Comparison of Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair and Tension-Free Herniorrhaphy Using Perfix(R): Short-Term Follow-Up Results

PURPOSE: Tension-free open repair for inguinal hernia is a safe and popular operation with a high success rate, but laparoscopic techniques are fairly recent. Comparing the tension-free herniorrhaphy using mesh and plug (Perfix(R)) with laparoscopic totally extraperitoneal (TEP) hernia repair is the aim of this study. METHODS: We compared two groups of patients in which 39 patients with inguinal hernias were treated by tension-free repair using Perfix(R) (group P) and 39 patients were treated by laparoscopic TEP repair (group T). Information about operation time, length of hospital stay, use of analgesics (pain), recurrence, complications, cosmetic satisfaction, medical costs, and time until return to work were evaluated retrospectively. RESULTS: Mean operation time, postoperative hospital stay, and the time until return to work were 101+/-33 min, 1.9+/-1.0 days, 11+/-8 days in group T, 86+/-28 min, 2.0+/-0.8 days, 12+/-10 days in group P. Postoperative complications, medical costs and the cosmetic satisfaction were 20.5%, 821,048 won, 94% (32/24) in group T, 7.7%, 692,149 won, 79% (19/24) in group P. There was difference between the two groups but not significant statistically. Group P used more analgesics than group T, significantly (P<0.05). There was only 1 recurrence in group T. CONCLUSION: Although we need more experience in patients with inguinal hernias, laparoscopic TEP repair may be a secure and feasible procedure compared to tension-free repair using Perfix(R).

The Effectiveness of Laparoscopic Ventral Hernia Repair with Transfascial Fixation / 대한내시경복강경외과학회지

PURPOSE: The introduction of a mesh to ventral herniorrhaphy ensures abdominal wall strength without tension, and this procedure has shown a decreased recurrence rate, a shorter hospital stay and less use of analgesics. However, the extensive tissue dissection required for mesh placement leads to increased postoperative complications. Yet with the development of laparoscopic ventral herniorrhaphy, we expect earlier recovery, fewer complications and decreased recurrence rates. This study was done to compare the outcomes after open and laparoscopic ventral herniorrhaphy with using mesh through a retrospective review. METHODS: The outcomes for 20 consecutive patients who underwent laparoscopic ventral herniorrhaphy were compared with those of 20 consecutive patients who underwent open herniorrhaphy. The laparoscopic repairs were performed using the intraperitoneal onlay mesh (IPOM) repair with transfascial fixation method in all the cases. RESULTS: The forty patients (24 women and 16 men) had a mean age of 57.48 years (range, 33~82). The mean follow-up time was 63.4 months. The mean surgery duration (67.4 min vs 142.3 min, respectively, p=0.003) and postoperative stay (4.7 vs 16.2 days, respectively, p<0.0001) were shorter for the laparoscopic group. The number of shots of analgesics during the first 3 days after surgery was 1.9 vs 2.4 shots, respectively (p=0.019). There were fewer complications (30%) and recurrences (5%) among the patients who underwent laparoscopic repair than those for the patients who underwent open repair (65% and 10 %, respectively). CONCLUSION: Those findings shows that laparoscopic ventral herniorrhaphy with transfascial fixation seems to be safe and effective and it showed a shorter operative time, fewer complications, a shorter hospital stay and less recurrence than did open ventral herniorrhaphy.

Modified Laparoscopic Totally Extraperitoneal Hernia Repair:Report of 31 Cases / 中国微创外科杂志

Objective To assess the feasibility and safety of modified laparoscopic totally extraperitoneal(TEP)hernia repair.Methods From January to August 2007,a total of 31 patients with hernia were treated with modified TEP hernia repair under general anesthesia in our hospital.During the operation,the anterior peritoneal space was separated,and then a domestic single balloon catheter was inserted into the extraperitoneal space to expand the latter.The mesh was not fixed during the operation.Results All the operations were successfully completed with a mean operation time of(69.8?21.8)minutes,mean blood loss of(7.6?4.2)ml,and mean postoperative hospital stay of(2.6?1.3)d.Five cases developed laceration of the peritoneum during the operation,and 2 had scrotal hydrocele after the operation.The patients were followed up for 1-7 months [mean,(4.2?2.4)months],no recurrence or chronic pain at operative area were found during this period.Conclusions Modified TEP is feasible for hernia repair.The method is a safe and tension-free technique with a low rate of postoperative chronic pain at the operation region.